Cal-Os/Cal-Os Plus D/Cal-Os Chew Special Precautions

Cal-Os Plus D: The drug accumulation may occur which can be dangerous, avoid overdose or prolonged use, use as directed by the physician.
The total amount of calcium intake from dietary and supplement should not exceed 1,500 mg/day.
Calcium absorption is impaired in achlorhydria; administration of calcium carbonate is followed by increased gastric acid secretion within 2 hours of administration especially with high doses. Common in elderly patients; use an alternate salt (e.g. citrate) and administer with food.
Hypercalcemia may occur when large doses of calcium are administered to patients with chronic renal failure. Mild hypercalcemia may exhibit as nausea, vomiting, anorexia, or constipation, with mental changes such as stupor, delirium, coma, or confusion. By reducing calcium intake, mild hypercalcemia is usually readily controlled. Chronic hypercalcemia may result in vascular calcification and other soft-tissue calcification.
Reduced calcium absorption may occur with calcium carbonate administration without food.
Use caution when administering calcium to patients with a history of kidney stones.
The milk-alkali syndrome of hypercalcemia, alkalosis and renal impairment may occur in patients who take large amounts of calcium and absorbable alkali.
Hypercalcemia may increase risk of cardiac arrythmias and seizures.
Cal-Os Chew: The major limiting factor to the chronic use of Calcium carbonate is gastric hypersecretion and acid rebound. Calcium carbonate may cause the milk-alkaline syndrome. Patient with renal impairment or dehydration and electrolyte imbalance are predisposed to developing the milk-alkaline syndrome. Serum calcium concentrations should be monitored weekly in patients receiving large dosages of Calcium carbonate.